Download - Hypoglycemia Presentation
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Hypoglycemia Prevention & Treatment
Gary Scheiner MS, CDEOwner, Integrated Diabetes Services333 E. Lancaster Ave., Suite 204Wynnewood, PA 19096877-SELF-MGT (735-3648)(610) [email protected]
- Hypoglycemia:DefinitionsMild: Adrenergic (BG
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Hypoglycemia:CauseImbalance between factors raising and lowering blood glucose levels
Blood Glucose Blood GlucoseFood Insulin/Oral MedsCounterregulatory HormonesPhysical Activity
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Hypoglycemia
The Greatest Limiting Factor In Diabetes Management
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The Great Limiting FactorPerformance Impairment
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The Great Limiting FactorAccident Risk
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The Great Limiting FactorAnxiety / Embarrassment
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The Great Limiting FactorLasting Damage?
Spatial memory / performance (if before age 5)
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The Great Limiting FactorDiminished Symptoms (Hypoglycemic Unawareness)
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The Great Limiting FactorRebound
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The Great Limiting FactorWeight Gain
- Hypoglycemia:Targets/GoalsUnable to recognize & verbalize lows: >80 (4.5 mmol)Able to recognize & verbalize lows: >70 (4 mmol)Pregnancy: >60 (3.3 mmol)
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Hypoglycemia Prevention Strategies1. Insulin Program Setup (background/basal)
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Hypoglycemia Prevention Strategies1. Insulin Program Setup (background/basal)
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Hypoglycemia Prevention Strategies1. Insulin Program Setup (background/basal)
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Hypoglycemia Prevention Strategies1. Insulin Program Setup (background/basal)
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Hypoglycemia Prevention Strategies1. Insulin Program Setup (background/basal)
Basal insulin should hold BG STEADY in the absence of food, exercise and bolus insulin!
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Hypoglycemia Prevention Strategies1b. Insulin Program Setup (Meal/Bolus)Only rapid analogs work when needed right after eating!
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Hypoglycemia Prevention Strategies2. Meal/Snack Timing
Major issue w/a.m. NPH/Lente Minor issue w/Lantus or Levemir Not usually an issue with pump use
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Hypoglycemia Prevention Strategies1500-Rule (aggressive) (83 rule)1800-Rule (conservative) (100 rule)(Total Daily Ins.)/1500 or 1800May vary day vs. night(nighttime often 50% more than day)3a. Proper Correction Doses
- Hypoglycemia Prevention StrategiesPremeal:100 (5.5) (aggressive)120 (6.7) (typical)140-150 (7.6-8.3) (cautious)3b. Appropriate BG TargetsPostmeal (1-2 hrs):
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Hypoglycemia Prevention StrategiesI:C Ratio that matches pre-meal BG 3-4 hours (not 2!) after eatingI:C Ratio often varies from meal to meal(bkfst dose > lunch & dinner)4. Proper Meal/Bolus Doses
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Hypoglycemia Prevention Strategies5. Account For Unused Insulin** Newer pumps figure this automatically based on the insulin duration you set.
Time since meal insulin 1 Hr2 Hrs3 Hrs4 HrsConservative Approach70% left40% left10% left0% leftAggressive Approach67% left33% left0% left
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Hypoglycemia Prevention Strategies5. Account For Unused InsulinExample:Gave 6.0 units at 7pm, BG 200 at 9pm.Conservative approach: 40% remaining (6 x .4) = 2.4 units leftAggressive approach: 33% remaining (6 x .33) = 2 units leftSubtract the unused insulin from your usual correction dose!
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Hypoglycemia Prevention Strategies6. Carb Counting Accuracy Proper Portion Measurement Look Up Unknown / Restaurant Foods Use Carb Factors Subtract 100% of Fiber Subtract 50% of Sugar Alcohols
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Hypoglycemia Prevention Strategies7. Extend Meal Insulin When NecessaryUse When: Portions are very large Meal is prolonged Food is low-glycemic index (pasta, legumes, dairy) Apply Via: Square/Dual/Extended/Combo bolus on pump Delayed or Split bolus on injections
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Hypoglycemia Prevention Strategies8. Adjustment for Physical Activity
Exercise, recreation, chores: all count! Reduce meal insulin (25%, 33%, 50%) for after-meal activity Snack prior to before/between meal activity Lower long-acting/basal insulin during and after prolonged activity
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Hypoglycemia Prevention Strategies8. Watch Out for DOH!(Delayed Onset Hypoglycemia)
Following High-Intensity Exercise Following Extended Duration Activity May Occur Up to 24 Hours After Adjustments to food/insulin after activity: lower basal insulin for 8-12 hours low-G.I. Snacks lower mealtime boluses
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Hypoglycemia Prevention Strategies9. Adjustment for Alcohol
Alcohol reduces the livers output of glucose and masks hypoglycemic symptoms Delayed BG drops can occur Decrease basal insulin (or overnight long-acting insulin) after drinking
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Hypoglycemia Prevention Strategies10. Consistent Monitoring
Before All Meals & Snacks Pre/Post Exercise Bedtime 3 a.m. (occasionally)
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Hypoglycemia Prevention Strategies11. Recording & Analysis
Record all pertinent data BGs Carb Activity Insulin Use an organized form (multiple days on single page, if possible)
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Gary Scheiner, MS, CDE
Integrated Diabetes Services
333 E. Lancaster Ave., Suite 204
Wynnewood, PA 19096
Phone: (610) 642-6055 Fax: (610) 642-8046
Name:
Weekly Diabetes Record
Date:
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Bedtime
Night
Notes
Blood Sugar
Insulin Dose
Grams Carb
Phys. Activity
Date:
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Bedtime
Night
Notes
Blood Sugar
Insulin Dose
Grams Carb
Phys. Activity
Date:
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Bedtime
Night
Notes
Blood Sugar
Insulin Dose
Grams Carb
Phys. Activity
Date:
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Bedtime
Night
Notes
Blood Sugar
Insulin Dose
Grams Carb
Phys. Activity
Date:
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Bedtime
Night
Notes
Blood Sugar
Insulin Dose
Grams Carb
Phys. Activity
Date:
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Bedtime
Night
Notes
Blood Sugar
Insulin Dose
Grams Carb
Phys. Activity
Date:
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Bedtime
Night
Notes
Blood Sugar
Insulin Dose
Grams Carb
Phys. Activity
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Hypoglycemia Prevention Strategies11. Recording & Analysis
Review every 7-10 days Look for patterns > 10% below target range @ given time Lows during/post-activity Lows on School/Work vs. off-day Lows Post-Menstrual
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Hypoglycemia Prevention Strategies12. Continuous Glucose Monitoring
Alarms to alert user/family of pending lows
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Hypoglycemia Prevention Strategies12. Continuous Glucose Monitoring
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Hypoglycemia TreatmentMild/Moderate LowCheck BG FirstTreat w/High-Glycemic Index FoodTreat w/Proper AmountRe-Check in 15 MinutesHigh-GI Foods Glucose Tablets Dry Cereal Pretzels Graham Crackers Vanilla Wafers Jelly Beans Gatorade
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Hypoglycemia TreatmentUse of Glycemic Index Lower GI foods digest & convert to glucose more slowly High-fiber slower than low Hi-fat slower than low Solids slower than liquids Cold foods slower than hot Type of sugar/starch affects GI
FastestGlucose
Dextrose
Starch (branched-chain)
Sucrose/Corn Syrup
Fructose
Starch (straight-chain)
Lactose
Galactose
SlowestSugar Alcohols
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Use of Glycemic Index (contd)Hypoglycemia Treatment
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Hypoglycemia TreatmentAlways Carry Rapid-Acting Carbs!
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Hypoglycemia TreatmentDEXTROSE Rules! Glucose TabletsSweet TartsSmartiesSpreeAir Heads
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Hypoglycemia TreatmentOnce BG has risen, give rapid-acting insulin to cover any overtreatment!
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Hypoglycemia TreatmentTreatment amt. for insulin on board Treatment amt. for recent exerciseTreatment amt. for previous low-G.I. foodsIdiosyncracies
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Hypoglycemia TreatmentSevere LowUnconscious / UnresponsiveSeizureUncooperative
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Take-Home MessagesQuantify Your LowsStrategize to MinimizePlan for Proper Treatment
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The Source of My Highs and Lows